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General NPI Number Information
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NPI Number | 1417270067
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Entity Type | Organization
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Legal Business Name | ENVISION PATHOLOGY LLC
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Dates
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Enumeration Date | 03/10/2010
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Last Update Date | 03/04/2016
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Provider Practice Location Address
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Address Line | 806 NORTH AVENUE K SUITE 101
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City | CROWLEY
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State | LA
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Zip | 70526
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Country | US
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Telephone | 888-950-0844
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Fax | 888-950-8714
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Provider Business Mailing Address
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Address Line | PO BOX 1563
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City | CROWLEY
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State | LA
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Zip | 70527-1563
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Country | US
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Telephone | 888-950-0844
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Fax | 888-950-8714
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Authorized Official
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Title or Position | CEO
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Name | TODD M LELEUX
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Credential | M.D.
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Telephone | 281-658-4408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 202714
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License Number State | LA
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